Dilator
Generic Name
Isosorbide Mononitrate
Manufacturer
Reputable Pharma Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| dilator 20 mg tablet | ৳ 4.00 | ৳ 40.00 |
Description
Overview of the medicine
Dilator 20 mg tablet is a nitrate vasodilator used to prevent and treat angina pectoris (chest pain) caused by coronary artery disease. It works by relaxing and widening blood vessels, improving blood flow to the heart.
Uses & Indications
Dosage
Adults
Initially 20 mg once daily, increasing to 20 mg twice daily after 1 week if needed. Doses should be separated by 7 hours to avoid tolerance (e.g., 8 AM and 3 PM).
Elderly
Similar to adult dosage, but caution required due to increased sensitivity and potential for hypotension.
Renal_impairment
No specific dosage adjustment required, but use with caution.
How to Take
Take orally with a glass of water, with or without food. Do not chew or crush the tablet.
Mechanism of Action
Isosorbide mononitrate is denitrated to nitric oxide (NO) in vascular smooth muscle cells. NO activates guanylate cyclase, leading to an increase in cyclic GMP (cGMP). cGMP causes dephosphorylation of myosin light chains, resulting in relaxation of smooth muscle, predominantly in veins, leading to venodilation and reduced preload. It also causes arterial dilation, reducing afterload.
Pharmacokinetics
Onset
30-60 minutes.
Excretion
Primarily renal as inactive metabolites.
Half life
Approximately 5 hours.
Absorption
Rapid and complete oral absorption, bioavailability 100%.
Metabolism
Primarily hepatic, undergoes denitration and glucuronidation.
Side Effects
Contraindications
- Hypersensitivity to isosorbide mononitrate or other nitrates
- Severe anemia
- Hypotension (systolic blood pressure < 90 mmHg)
- Concomitant use with phosphodiesterase-5 inhibitors (e.g., sildenafil, tadalafil)
- Acute circulatory failure or shock
Drug Interactions
Alcohol
May increase hypotensive effects.
Phosphodiesterase-5 inhibitors (e.g., sildenafil, tadalafil)
Profound and prolonged hypotensive effects, potentially life-threatening.
Other vasodilators, calcium channel blockers, beta-blockers, diuretics, antihypertensives
May potentiate hypotensive effects.
Storage
Store in a cool, dry place below 30°C. Protect from light and moisture. Keep out of reach of children.
Overdose
Symptoms include severe hypotension, reflex tachycardia, flushing, headache, dizziness, syncope, and methemoglobinemia. Treatment is symptomatic and supportive, including elevation of legs, intravenous fluids, and if necessary, methemoglobinemia treatment (e.g., methylene blue).
Pregnancy & Lactation
Pregnancy Category C. Use only if potential benefit justifies potential risk to the fetus. It is unknown whether isosorbide mononitrate is excreted in human milk; caution should be exercised when administered to a nursing woman.
Side Effects
Contraindications
- Hypersensitivity to isosorbide mononitrate or other nitrates
- Severe anemia
- Hypotension (systolic blood pressure < 90 mmHg)
- Concomitant use with phosphodiesterase-5 inhibitors (e.g., sildenafil, tadalafil)
- Acute circulatory failure or shock
Drug Interactions
Alcohol
May increase hypotensive effects.
Phosphodiesterase-5 inhibitors (e.g., sildenafil, tadalafil)
Profound and prolonged hypotensive effects, potentially life-threatening.
Other vasodilators, calcium channel blockers, beta-blockers, diuretics, antihypertensives
May potentiate hypotensive effects.
Storage
Store in a cool, dry place below 30°C. Protect from light and moisture. Keep out of reach of children.
Overdose
Symptoms include severe hypotension, reflex tachycardia, flushing, headache, dizziness, syncope, and methemoglobinemia. Treatment is symptomatic and supportive, including elevation of legs, intravenous fluids, and if necessary, methemoglobinemia treatment (e.g., methylene blue).
Pregnancy & Lactation
Pregnancy Category C. Use only if potential benefit justifies potential risk to the fetus. It is unknown whether isosorbide mononitrate is excreted in human milk; caution should be exercised when administered to a nursing woman.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
36 months
Availability
Available in pharmacies, hospitals, and clinics
Approval Status
Approved by FDA and DGDA
Patent Status
Generic available, patent expired
WHO Essential Medicine
YesClinical Trials
Extensive clinical trials have established the efficacy and safety of isosorbide mononitrate in the prophylaxis and treatment of angina pectoris, demonstrating significant reduction in anginal attacks and improved exercise tolerance.
Lab Monitoring
- Blood pressure monitoring
- Heart rate monitoring
- Methemoglobin levels (in cases of overdose/toxicity)
Doctor Notes
- Emphasize the importance of nitrate-free interval to prevent tolerance.
- Counsel patients on orthostatic hypotension and how to manage it.
- Crucial to screen for concurrent PDE5 inhibitor use.
Patient Guidelines
- Do not stop taking this medicine abruptly without consulting your doctor.
- Avoid sudden changes in posture to prevent dizziness.
- Report any severe headache or fainting immediately.
Missed Dose Advice
If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.
Driving Precautions
May cause dizziness or lightheadedness, especially at the start of treatment or after a dose increase. Avoid driving or operating machinery until you know how this medicine affects you.
Lifestyle Advice
- Maintain a healthy diet low in saturated fats and cholesterol.
- Engage in regular moderate exercise as advised by your doctor.
- Avoid smoking and limit alcohol consumption.
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Global Brand Names
International brand names for this medicine. Click a brand to search for detailed information.
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